Aim： To detect the expression of VASA in human ejaculated spermatozoa, and to compare the expression of VASA between normozoospermic men and patients with oligozoospermia. Methods： Ejaculated spermatozoa were collec...Aim： To detect the expression of VASA in human ejaculated spermatozoa, and to compare the expression of VASA between normozoospermic men and patients with oligozoospermia. Methods： Ejaculated spermatozoa were collected from normozoospermic men and patients with oligozoospermia by masturbation, and subsequently segregated through a discontinuous gradient of Percoll to obtain the spermatozoa. Reverse transcription polymerase chain reaction （RT- PCR）, quantitative RT-PCR （QRT-PCR）, immunoflurescence and Western blotting were used to detect the expression of VASA in mRNA and protein levels. Results： VASA mRNA was expressed in the ejaculated spermatozoa. QRT-PCR analysis showed that VASA mRNA level was approximately 5-fold higher in normozoospermic men than that in oligozoospermic men. Immunofluorescence and Western blotting analysis showed that VASA protein was located on the cytoplasmic membrane of heads and tails of spermatozoa, and its expression was significantly decreased in oligozoospermic men, which is similar to the result of QRT-PCR. Conclusion： The expression of VASA mRNA and protein was significantly decreased in the sperm of oligozoospermic men, which suggested the lower expression of the VASA gene might be associated with pathogenesis in some subtypes of male infertility and VASA could be used as a molecular marker for the diagnosis of male infertility.展开更多
Studies have explored the assisted reproductive technology(ART)outcomes of Y-chromosome azoospermia factor c(AZFc)microdeletions,but the effect of sperm source on intracytoplasmic sperm injection(ICSI)remains unknown....Studies have explored the assisted reproductive technology(ART)outcomes of Y-chromosome azoospermia factor c(AZFc)microdeletions,but the effect of sperm source on intracytoplasmic sperm injection(ICSI)remains unknown.To determine the ART results of ICSI using testicular sperm and ejaculated sperm from males with AZFc microdeletions,we searched Embase,Web of Science,and PubMed to conduct a systematic review and meta-analysis.The first meta-analysis results for 106 cycles in five studies showed no significant differences in the live birth rate between the testicular sperm group and the ejaculated sperm group(risk ratio:0.97,95%confidence interval[CI]:0.73-1.28,P=0.82).The second meta-analysis of 106 cycles in five studies showed no difference in the abortion rate between the testicular sperm group and ejaculated sperm group(risk ratio:1.06,95%Cl:0.54-2.06,P=0.87).The third meta-analysis of 386 cycles in seven studies showed no significant difference in clinical pregnancy rates between the testicular sperm group and the ejaculated sperm group(risk ratio:1.24,95%Cl:0.66-2.34,P=0.50).Inevitable heterogeneity weakened our results.However,our results indicated that testicular sperm and ejaculated sperm yield similar ART outcomes,representing a meaningful result for clinical treatment.More properly designed studies are needed to further confirm our conclusions.展开更多
Dear Editor,We recently reviewed two important studies that investigate the use of botulinum-A toxin(BoNT-A)injections into the bulbospongiosus muscle as a treatment for lifelong premature ejaculation(PE).While both s...Dear Editor,We recently reviewed two important studies that investigate the use of botulinum-A toxin(BoNT-A)injections into the bulbospongiosus muscle as a treatment for lifelong premature ejaculation(PE).While both studies share the goal of evaluating the efficacy and safety of BoNT-A in this context,they reached very different conclusions.The study by Shaher et al.demonstrated significant improvements in ejaculatory latency,indicating that BoNT-A injections may be a helpful treatment for PE.展开更多
Background: The prevalence of benign prostatic hyperplasia, BPH is increasing in our environment. Besides androgens and age could there be other risk factors? Aim: To investigate the roles of sexually transmitted infe...Background: The prevalence of benign prostatic hyperplasia, BPH is increasing in our environment. Besides androgens and age could there be other risk factors? Aim: To investigate the roles of sexually transmitted infections, STI and frequency of ejaculation as risk factors for BPH. Methods: It was a prospective observational study carried out among predominantly Christian communities near Port Harcourt, a major cosmopolitan city in the oil rich Rivers State, in the Niger Delta region of Nigeria. Adult males above the age of 40 yrs old with no history of prostate cancer were invited to participate. History of marriage, duration of marriage, number of wives/sexual partners, frequency of sex or ejaculation and present or past history of STI were obtained through an interpreter administered questionnaire. Diagnosis of BPH was based on presence of lower urinary tract symptoms, ultrasound determination of increased prostate size and histopathology report to rule out prostate cancer. Linear logistic regression and odds ration were used to establish strength of association between BPH and frequency of ejaculation and history of various causative organisms for STI. Statistical significance was determined at p value of Results: 754 respondents participated. Age ranged from 40 to 81 years. 92.6% were in a single relationship. 58.4% had 1 - 5 ejaculations per week. 8.2% has had syphilis, 32.6% has had gonorrhea and 1.1% has had candida infection. There was an observed positive relationship between history of gonorrhoea and increase in prostate size but the association was not statistically significant;syphilis showed no positive relationship with prostate enlargement;incidence of candidiasis was too low to establish causal relationship. Individuals who had sex once a week or less showed a higher prevalence of moderate/severe enlargement (42.3%) compared to those with more frequent sexual activity (35.7%) a relationship that approached significance (p = 0.071), with an odds ratio of 1.3 and narrow CI (0.9 to 1.7), suggesting a potential association that requires further investigation. Conclusion: There is an observed causal relationship between both previous history of gonorrhea infection and reduced frequency of ejaculation and prostate enlargement but these associations do not attain statistical significance and would need further studies.展开更多
Introduction: Benign prostatic hyperplasia (BPH) is a benign neoplasm that develops from the constituent elements of the prostate. It is a common age-related condition, with more than 50% of men over 50 years old exhi...Introduction: Benign prostatic hyperplasia (BPH) is a benign neoplasm that develops from the constituent elements of the prostate. It is a common age-related condition, with more than 50% of men over 50 years old exhibiting symptoms indicative of BPH. It is the main cause of lower urinary tract symptoms (LUTS). Materials and Methods: This was a prospective, descriptive and longitudinal study over a six-month period from December 15, 2023, to May 15, 2024. All patients admitted for BPH and who received medication treatment during this period were included in the study. Results: The average age of patients was 65.4 years, with the 60 to 69-year age group being the most represented (37.18%). There was no statistical link between the level of education and the occurrence of erection dysfunction ED. 66.67% of patients suffered from ED before treatment. Age was a major risk factor. 94.87% of patients were treated with Alpha-blockers due to their tolerance and effectiveness. 14.10% of patients had a history of inguinal herniorrhaphy, often due to the strain of urination and physical labor. 46.16% of patients had hypertension. No significant link was found between comorbidities and ED. 38.45% of patients consumed tobacco or alcohol. Tobacco was a significant risk factor for ED. 57.67% of patients suffered from ED after treatment, indicating an improvement compared to 66.67% before treatment. However, 24.36% did not ejaculate during sexual intercourse. Conclusion: Medication treatment is the first-line treatment for BPH. However, it can lead to retrograde ejaculation, negatively impacting ejaculatory function. The results showed that the treatment improves patients’ sexuality (IIEF-5 score), but age and tobacco consumption increase the risk of sexual dysfunction.展开更多
A previous study showed that the length of the foreskin plays a role in the risk of sexually transmitted infections and chronic prostatitis,which can lead to poor quality of sexual life.Here,the association between fo...A previous study showed that the length of the foreskin plays a role in the risk of sexually transmitted infections and chronic prostatitis,which can lead to poor quality of sexual life.Here,the association between foreskin length and sexual dysfunction was evaluated.A total of 5700 participants were recruited from the andrology clinic at The First Affiliated Hospital of University of Science and Technology of China(Hefei,China).Clinical characteristics,including foreskin length,were collected,and sexual function was assessed by the International Index of Erectile Function-5(IIEF-5)and Premature Ejaculation Diagnostic Tool(PEDT)questionnaires.Men with sexual dysfunction were more likely to have redundant foreskin than men without sexual dysfunction.Among the 2721 erectile dysfunction(ED)patients and 1064 premature ejaculation(PE)patients,301(11.1%)ED patients and 135(12.7%)PE patients had redundant foreskin,respectively.Men in the PE group were more likely to have redundant foreskin than men in the non-PE group(P=0.004).Logistic regression analyses revealed that the presence of redundant foreskin was associated with increased odds of moderate/severe ED(adjusted odds ratio[aOR]=1.31,adjusted P=0.04),moderate PE(aOR=1.38,adjusted P=0.02),and probable PE(aOR=1.37,adjusted P=0.03)after adjusting for confounding variables.Our study revealed a positive correlation between the presence of redundant foreskin and the risk of sexual dysfunction,especially in PE patients.Assessment of the length of the foreskin during routine clinical diagnosis may provide information for patients with sexual dysfunction.展开更多
Dear Editor,Primary bladder neck obstruction(PBNO)affects approximately 28%–54%of men[1].Its etiology remains unclear.Symptoms of PBNO present as voiding(e.g.,decreased force of stream,hesitancy,intermittent stream,a...Dear Editor,Primary bladder neck obstruction(PBNO)affects approximately 28%–54%of men[1].Its etiology remains unclear.Symptoms of PBNO present as voiding(e.g.,decreased force of stream,hesitancy,intermittent stream,and incomplete emptying),storage(e.g.,frequency,urgency,urge incontinence,and nocturia),or a combination of both[2].Untreated PBNO can lead to bladder dysfunction,bladder diverticula,hydronephrosis,and impaired renal function[3].展开更多
Objective To investigate the empty zona pellucida for use in the cryopreservation of human sperm. Materials & Methods Human and hamster zona pellucidae were evacuated and injected with testicular, epididymal ...Objective To investigate the empty zona pellucida for use in the cryopreservation of human sperm. Materials & Methods Human and hamster zona pellucidae were evacuated and injected with testicular, epididymal and ejaculated sperm. The zona pellucidae with sperm were cryopreserved. Results After thawing, zona pellucidae were easily found, and sperm inside zona pellucidae were also easily observed. There were no differences in post-thaw motility and vitality between ejaculated and epididymal sperm groups (P>0.05), but these two parameters were lowered in testicular sperm group compared to both ejaculated and epididymal sperm (P<0.01). No significant difference was observed in post-thaw motilities among 6%, 7.5%, 9% glycerol concentrations (P>0.05). In addition, obvious differences in post-thaw motilities were not found between human and hamster empty zona pellucidae (P>0.05). Conclusion An evacuated zona pellucida is an ideal vehicle for the cryopreservation of a small number of human sperm.展开更多
Aim: To assess the psychometric properties of the Chinese Index of Premature Ejaculation (CIPE). Methods: The sexual function of 167 patients with and 114 normai controls without premature ejaculation (PE) were evalua...Aim: To assess the psychometric properties of the Chinese Index of Premature Ejaculation (CIPE). Methods: The sexual function of 167 patients with and 114 normai controls without premature ejaculation (PE) were evaluated with CIPE. All subjects were married and had regular sexual activity. The CIPE has 10 questions, focusing on libido, erectile function, ejaculatory latency, sexual satisfaction and difficulty in delaying ejaculation, self-confi dence and depression. Each question was responded to on a 5 point Likert-type scale. The individual question score and the total scale score were analyzed between the two groups. Results: There were no significant differences between the age, duration of marriage and educational level (P > 0.05) of patients with and vvithout PE and normai controls. The mean latency of patients with PE and normai controls were 1.6±1.2 and 10.2±9.5 minutes, respectively. Significant differences between patients with (26.7±4.6) PE and normai controls (41.9±4.0) were observed on the total score of CIPE (P < 0.01). Using binary logistic regression analysis, PE was significantly related to five questions of the original measure. They are the so-called the CIPE-5 and include: ejaculatory latency, sexual satisfaction of patients and sexual partner, difficulty in delaying ejaculation, anxiety and depression. Receiver Operat ing Characteristic (ROC) curve analysis of CIPE-5 questionnaire indicated that the sensitivity and specificity of CIPE were 97.60 % and 94.74 %, respectively. Employing the total score of CIPE-5, patients with PE could be divided into three groups: mild (>15 point) 19.8 %, moderate (10-14 point) 62.8 % and severe (< 9 point) 16.7 %. Conclusion: The CIPE-5 is a useful method for the evaluation of sexual function of patients with PE and can be used as a clinical endpoint for clinical trials studying the efficacy of pharmacologica] intervention.展开更多
There are ongoing debates about the definition, classification and prevalence of premature ejaculation （PE）. The first evidence-based definition of PE was limited to heterosexual men with lifelong PE who engage in v...There are ongoing debates about the definition, classification and prevalence of premature ejaculation （PE）. The first evidence-based definition of PE was limited to heterosexual men with lifelong PE who engage in vaginal intercourse. Unfortunately, many patients with the complaint of PE do not meet these criteria. However, these men can be diagnosed as one of the PE subtypes, namely acquired PE, natural variable PE or premature-like ejaculatory dysfunction. Nevertheless, the validity of these subtypes has not yet been supported by evidence. The absence of a universally accepted PE definition and lack of standards for data acquisition have resulted in prevalence studies that have reported conflicting rates. The very high prevalence of 20%-30% is probably due to the vague terminology used in the definitions at the time when such surveys were conducted. Although many men may complain of PE when questioned for a population-based prevalence study, only a few of them will actively seek treatment for their complaint, even though most of these patients would define symptoms congruent with PE. The complaints of acquired PE patients may be more severe, whereas complaints of patients experiencing premature-like ejaculatory dysfunction seem to be least severe among men with various forms of PE. Although numerous treatment modalities have been proposed for management of PE, only antidepressants and topical anaesthetic creams have currently been proven to be effective. However, as none of the treatment modalities have been approved by the regulatory agencies, further studies must be carried to develop a beneficial treatment strategy for PE.展开更多
Premature ejaculation(PE)is the most comm on male sexual dysfunction,which represents a diag no stic as well as a therapeutic challenge for physicians.However,no universally accepted definition is currently available ...Premature ejaculation(PE)is the most comm on male sexual dysfunction,which represents a diag no stic as well as a therapeutic challenge for physicians.However,no universally accepted definition is currently available for PE.As a result,physicians continue to diagnose patients with PE according to major guidelines set by the professional societies.These guidelines either recommend the use of validated questionnaires or patient-reported outcomes.Recent efforts directed toward classifying PE may help provide a better understanding of the prevalence and risk factors of this disorder.While the exact etiology of PE has not been clearly elucidated,several risk factors have been strongly reported in the literature.Clearly,to understand the revised definition of PE,its etiology and pathophysiology is necessary to improve the clinical management of this medical condition and form the basis of future research in this regard.In this review,we highlight the past and current definitions of PE and present an appraisal on the classifications and theories suggested for the etiopathogenesis of PE.展开更多
Premature ejaculation （PE） is recognized to be the most common male sexual disorder. PE provides difficulties for professionals who treat this condition because there is neither a universally accepted definition nor...Premature ejaculation （PE） is recognized to be the most common male sexual disorder. PE provides difficulties for professionals who treat this condition because there is neither a universally accepted definition nor a medication approved by the Food and Drug Administration （FDA）. Despite these shortcomings, physicians continue to diagnose their patients with PE according to major guidelines and treat them with either behavioral therapies or off-label medications. This review focuses on current and emerging treatment options and medications for PE. Advantages and limitations of each treatment option are discussed in the light of current published peer-reviewed literature.展开更多
Sex has always been a taboo subject in Asian society. However, over the past few years, awareness in the field of men＇s sexual health has improved, and interest in sexual health research has recently increased. The e...Sex has always been a taboo subject in Asian society. However, over the past few years, awareness in the field of men＇s sexual health has improved, and interest in sexual health research has recently increased. The epidemiology and prevalence of erectile dysfunction, hypogonadism and premature ejaculation in Asia are similar in the West. However, several issues are specific to Asian males, including culture and beliefs, awareness, compliance and the availability of traditional/complementary medicine. In Asia, sexual medicine is still in its infancy, and a concerted effort from the government, relevant societies, physicians and the media is required to propel sexual medicine to the forefront of health care.展开更多
We evaluated the genotypes of the serotonin transporter gene （5-HTT） in patients with premature ejaculation （PE） to determine the role of genetic factors in the etiopathogenesis of PE and possibly to identify the ...We evaluated the genotypes of the serotonin transporter gene （5-HTT） in patients with premature ejaculation （PE） to determine the role of genetic factors in the etiopathogenesis of PE and possibly to identify the patient subgroups. A total of 70 PE patients and 70 controls were included in this study. All men were heterosexual, had no other disorders and were either married or in a stable relationship. PE was defined as ejaculation that occurred within 1 min of vaginal intromission. Genomic DNA from patients and controls was analyzed using polymerase chain reaction, and allelic variations of the promoter region of the serotonin transporter gene （5-HTTLPR） were determined. The 5-HTTLPR （serotonin transporter promoter gene） genotypes in PE patients vs. controls were distributed as follows： L/L 16% vs. 17%, L/S 30% vs. 53% and S/S 54% vs. 28%. We examined the haplotype analysis for three polymorphisms of the 5-HTTLPR gene： LL, LS and SS. The appropriateness of the allele frequencies in the 5-HTTLPR gene was analyzed by the Hardy-Weinberg equilibrium using the Z-test. The short （S） allele of the 5-HTTLPR gene was significantly more frequent in PE patients than in controls （P 〈 0.05）. We suggest that the 5-HTTLPR gene plays a role in the pathophysiology of all primary PE cases. Further studies are needed to evaluate the relationship between 5-HTTLPR gene polymorphism and patient subgroup （such as primary and secondary PE） responses to selective serotonin reuptake inhibitors as well as ethnic differences.展开更多
Penile hypersensitivity plays an important role in premature ejaculation （PE）, but differences in penile sensitivity among subtypes of PE are unknown. Therefore, we compared penile sensory thresholds in PE subtypes ...Penile hypersensitivity plays an important role in premature ejaculation （PE）, but differences in penile sensitivity among subtypes of PE are unknown. Therefore, we compared penile sensory thresholds in PE subtypes of lifelong and acquired PE, PE with and without erectile dysfunction （ED）, PE with an intravaginal ejaculation latency time 〈1 min and 〉1 min, and PE with and without orgasmic pleasure perceptual dysfunction. During August 2014 to January 2016, 136 patients with PE were included. Penile warm, cold, and vibratory thresholds were measured. Data of clinical characteristics, sexual life, Premature Ejaculation Diagnostic Tool （PEDT） score, and the 5-item version of the International Index of Erectile Function （IIEF-5） score were collected. Vibratory thresholds of the PE with ED group were higher in the right coronal sulcus （median amplitude： 4.92 vs 3.65 μm, P= 0.02） and the right penile shaft （median amplitude： 3.87 vs 3.30 μm, P = 0.03）, while differences in penile sensory thresholds between other subtypes were not significant. The median PEDT score was lower in the PE without ED group （12 vs 14, P 〈 0.001）. The IIEF-5 and PEDT scores were negatively correlated （r = -0.29, P 〈 0.001）. Patients with orgasmic pleasure perceptual dysfunction had a lower median IIEF-5 score （20 vs 21, P = 0.02）. Patients with PE and ED had lower penile sensitivity, and ED was associated with more severe symptoms and weaker orgasmic pleasure perception. In men with PE, management of comorbid ED is necessary. In case of side effects in erectile function, topical anesthetics should be cautiously used in men with PE and ED.展开更多
We aimed to prospectively evaluate the influence of holmium laser enucleation of the prostate （HoLEP） on the overall postoperative sexual function of benign prostatic hyperplasia （BPH） patients with lower urinary ...We aimed to prospectively evaluate the influence of holmium laser enucleation of the prostate （HoLEP） on the overall postoperative sexual function of benign prostatic hyperplasia （BPH） patients with lower urinary tract symptoms （LUTS） and to explore the relationship between sexual function and LUTS. From January 2010 to December 2011, sixty sexually active consecutive patients with BPH who underwent HoLEP were prospectively enrolled in the study. All patients filled out the Male Sexual Health Questionnaire （MSHQ） for evaluation of their overall sexual function and the International Prostatic Symptom Score （IPSS） for pre- and post-operative 6 months evaluation of their voiding symptoms. The LUTS and sexual function changes were statistically analyzed. The preoperative and 6 months postoperative status of the patients was compared using uroflowmetry and IPSS questionnaires. The analysis revealed significant improvements following HoLEP. Among the sub-domains of the MSHQ, postoperative sexual function, including erection, ejaculation, sexual satisfaction, anxiety or sexual desire, did not significantly change after HoLEP （P 〉 0.05）, whereas satisfaction scores decreased slightly due to retrograde ejaculation in 38 patients （63.3%）. Sexual satisfaction improved significantly and was correlated with the improvements of all LUTS and the quality-of-life （QoL） domains in IPSS after surgery （QoL; relative risk [RR]： -0.293; total symptoms, RR： -0.411; P 〈 0.05）. The nocturia score was associated with the erectile function score （odds ratio 0.318, P = 0.029）. The change in ejaculatory scores did not show significant association with IPSS scores. HoLEP did not influence overall sexual function, including erectile function. In addition, sexual satisfaction improved in proportion with the improvement of LUTS.展开更多
Normal sexual and reproductive functions depend largely on neurological mechanisms. Neurological defects in men can cause infertility through erectile dysfunction, ejaculatory dysfunction and semen abnormalities. Amon...Normal sexual and reproductive functions depend largely on neurological mechanisms. Neurological defects in men can cause infertility through erectile dysfunction, ejaculatory dysfunction and semen abnormalities. Among the major conditions contributing to these symptoms are pelvic and retroperitoneal surgery, diabetes, congenital spinal abnormalities, multiple sclerosis and spinal cord injury, Erectile dysfunction can be managed by an increasingly invasive range of treatments including medications, injection therapy and the surgical insertion of a penile implant. Retrograde ejaculation is managed by medications to reverse the condition in mild cases and in bladder harvest of semen after ejaculation in more severe cases. Anejaculation might also be managed by medication in mild cases while assisted ejaculatory techniques including penile vibratory stimulation and eiectroejaculation are used in more severe cases. If these measures fail, surgical sperm retrieval can be attempted. Ejaculation with penile vibratory stimulation can be done by some spinal cord injured men and their partners at home, followed by in-home insemination if circumstances and sperm quality are adequate. The other options always require assisted reproductive techniques including intrauterine insemination or in vitrofertilization with or without intracytoplasmic sperm injection. The method of choice depends largely on the number of motile sperm in the ejaculate.展开更多
Treatment of patients with lower urinary tract symptoms （LUTS） secondary to benign prostatic hyperplasia （BPH） may affect the quality of sexual function and ejaculation. The effect of new surgical procedures, whic...Treatment of patients with lower urinary tract symptoms （LUTS） secondary to benign prostatic hyperplasia （BPH） may affect the quality of sexual function and ejaculation. The effect of new surgical procedures, which are currently available to treat BPH, on erection and ejaculation, has been poorly studied. This study aimed to assess the effect of thulium laser enucleation of the prostate （ThuLEP） on sexual function and retrograde ejaculation in patients with LUTS secondary to BPH. We performed a prospective study in 110 consecutive patients who had undergone ThuLEP to analyze changes in sexual function and urinary symptoms. To evaluate changes in erection and ejaculation, and the effect of urinary symptoms on the quality of life （QoL）, five validated questionnaires were used： the ICIQ-MLUTSsex, MSHQ-EjD, International Index of Erectile Function 5, International Prognostic Scoring System （IPSS） questionnaire, and QoL index of the intraclass correlation coefficients. Patients also underwent IPSS and flowmetry to assess the outcome of flow. Patients were evaluated before surgery and 3-6 months after ThuLEP, whereas those with previous abdominal surgery were excluded. The patients＇ mean age was 67.83 years. Postoperative urinary symptoms improved after surgery. No significant differences in erectile function before and after surgery were observed. As compared with other techniques described in the literature, the percentage of patients with conserved ejaculation increased by 52.7% after ThuLEP. ThuLEP positively affects urinary symptoms and their effect on the QoL of patients as assessed by questionnaire scores. While endoscopic management of BPH （e.g. transurethral resection of the prostate） causes retrograde ejaculation in most patients, those who undergo ThuLEP have conserved ejaculation and erectile function.展开更多
The aim of the study was to evaluate the long-term outcomes of pelvic floor muscle （PFM） rehabilitation in males with lifelong premature ejaculation （PE）, using intravaginal ejaculatory latency time （IELT） and t...The aim of the study was to evaluate the long-term outcomes of pelvic floor muscle （PFM） rehabilitation in males with lifelong premature ejaculation （PE）, using intravaginal ejaculatory latency time （IELT） and the self-report Premature Ejaculation Diagnostic Tool （PEDT） as primary outcomes. A total of 154 participants were retrospectively reviewed in this study, with 122 completing the training protocol. At baseline, all participants had an IELT 〈60 s and PEDT score 〉11. Participants completed a 12-week program of PFM rehabilitation, including physio-kinesiotherapy treatment, electrostimulation, and biofeedback, with three sessions per week, with 20 min for each component completed at each session. The effectiveness of intervention was evaluated by comparing the change in the geometric mean of IELT and PEDT values, from baseline, at 3, 6, and 12 months during the intervention, and at 24 and 36 months postintervention, using a paired sample 2-tailed t-test, including the associated 95% confidence intervals. Of the 122 participants who completed PFM rehabilitation, 111 gained control of their ejaculation reflex, with a mean IELT of 161.6 s and PEDT score of 2.3 at the 12-week endpoint of the intervention, representing an increase from baseline of 40.4 s and 17.0 scores, respectively, for IELT and PEDT （P 〈 0.0001）. Of the 95 participants who completed the 36-month follow-up, 64% and 56% maintained satisfactory eiaculation control at 24 and 36 months oostintervention, respectively.展开更多
基金We would like to thank Mr Jian-Rong Zhang, Mr Li-Bing Zhang and Dr Zhen-Dong Yu for technical assistance. This work was supported by grants from the National Natural Science Foundation of China （No. 30500543）, Ministry of Education ＂985 project＂ （No. 985-2-054-29）, and Shenzhen Foundation of Science ＆ Technology （JH200505270413B）.
文摘Aim： To detect the expression of VASA in human ejaculated spermatozoa, and to compare the expression of VASA between normozoospermic men and patients with oligozoospermia. Methods： Ejaculated spermatozoa were collected from normozoospermic men and patients with oligozoospermia by masturbation, and subsequently segregated through a discontinuous gradient of Percoll to obtain the spermatozoa. Reverse transcription polymerase chain reaction （RT- PCR）, quantitative RT-PCR （QRT-PCR）, immunoflurescence and Western blotting were used to detect the expression of VASA in mRNA and protein levels. Results： VASA mRNA was expressed in the ejaculated spermatozoa. QRT-PCR analysis showed that VASA mRNA level was approximately 5-fold higher in normozoospermic men than that in oligozoospermic men. Immunofluorescence and Western blotting analysis showed that VASA protein was located on the cytoplasmic membrane of heads and tails of spermatozoa, and its expression was significantly decreased in oligozoospermic men, which is similar to the result of QRT-PCR. Conclusion： The expression of VASA mRNA and protein was significantly decreased in the sperm of oligozoospermic men, which suggested the lower expression of the VASA gene might be associated with pathogenesis in some subtypes of male infertility and VASA could be used as a molecular marker for the diagnosis of male infertility.
基金the Project of Medical Science and Technology Research Foundation of Guangdong Province(No.A2019336)Guangzhou Science and Technology Plan Project(No.201707010394).
文摘Studies have explored the assisted reproductive technology(ART)outcomes of Y-chromosome azoospermia factor c(AZFc)microdeletions,but the effect of sperm source on intracytoplasmic sperm injection(ICSI)remains unknown.To determine the ART results of ICSI using testicular sperm and ejaculated sperm from males with AZFc microdeletions,we searched Embase,Web of Science,and PubMed to conduct a systematic review and meta-analysis.The first meta-analysis results for 106 cycles in five studies showed no significant differences in the live birth rate between the testicular sperm group and the ejaculated sperm group(risk ratio:0.97,95%confidence interval[CI]:0.73-1.28,P=0.82).The second meta-analysis of 106 cycles in five studies showed no difference in the abortion rate between the testicular sperm group and ejaculated sperm group(risk ratio:1.06,95%Cl:0.54-2.06,P=0.87).The third meta-analysis of 386 cycles in seven studies showed no significant difference in clinical pregnancy rates between the testicular sperm group and the ejaculated sperm group(risk ratio:1.24,95%Cl:0.66-2.34,P=0.50).Inevitable heterogeneity weakened our results.However,our results indicated that testicular sperm and ejaculated sperm yield similar ART outcomes,representing a meaningful result for clinical treatment.More properly designed studies are needed to further confirm our conclusions.
文摘Dear Editor,We recently reviewed two important studies that investigate the use of botulinum-A toxin(BoNT-A)injections into the bulbospongiosus muscle as a treatment for lifelong premature ejaculation(PE).While both studies share the goal of evaluating the efficacy and safety of BoNT-A in this context,they reached very different conclusions.The study by Shaher et al.demonstrated significant improvements in ejaculatory latency,indicating that BoNT-A injections may be a helpful treatment for PE.
文摘Background: The prevalence of benign prostatic hyperplasia, BPH is increasing in our environment. Besides androgens and age could there be other risk factors? Aim: To investigate the roles of sexually transmitted infections, STI and frequency of ejaculation as risk factors for BPH. Methods: It was a prospective observational study carried out among predominantly Christian communities near Port Harcourt, a major cosmopolitan city in the oil rich Rivers State, in the Niger Delta region of Nigeria. Adult males above the age of 40 yrs old with no history of prostate cancer were invited to participate. History of marriage, duration of marriage, number of wives/sexual partners, frequency of sex or ejaculation and present or past history of STI were obtained through an interpreter administered questionnaire. Diagnosis of BPH was based on presence of lower urinary tract symptoms, ultrasound determination of increased prostate size and histopathology report to rule out prostate cancer. Linear logistic regression and odds ration were used to establish strength of association between BPH and frequency of ejaculation and history of various causative organisms for STI. Statistical significance was determined at p value of Results: 754 respondents participated. Age ranged from 40 to 81 years. 92.6% were in a single relationship. 58.4% had 1 - 5 ejaculations per week. 8.2% has had syphilis, 32.6% has had gonorrhea and 1.1% has had candida infection. There was an observed positive relationship between history of gonorrhoea and increase in prostate size but the association was not statistically significant;syphilis showed no positive relationship with prostate enlargement;incidence of candidiasis was too low to establish causal relationship. Individuals who had sex once a week or less showed a higher prevalence of moderate/severe enlargement (42.3%) compared to those with more frequent sexual activity (35.7%) a relationship that approached significance (p = 0.071), with an odds ratio of 1.3 and narrow CI (0.9 to 1.7), suggesting a potential association that requires further investigation. Conclusion: There is an observed causal relationship between both previous history of gonorrhea infection and reduced frequency of ejaculation and prostate enlargement but these associations do not attain statistical significance and would need further studies.
文摘Introduction: Benign prostatic hyperplasia (BPH) is a benign neoplasm that develops from the constituent elements of the prostate. It is a common age-related condition, with more than 50% of men over 50 years old exhibiting symptoms indicative of BPH. It is the main cause of lower urinary tract symptoms (LUTS). Materials and Methods: This was a prospective, descriptive and longitudinal study over a six-month period from December 15, 2023, to May 15, 2024. All patients admitted for BPH and who received medication treatment during this period were included in the study. Results: The average age of patients was 65.4 years, with the 60 to 69-year age group being the most represented (37.18%). There was no statistical link between the level of education and the occurrence of erection dysfunction ED. 66.67% of patients suffered from ED before treatment. Age was a major risk factor. 94.87% of patients were treated with Alpha-blockers due to their tolerance and effectiveness. 14.10% of patients had a history of inguinal herniorrhaphy, often due to the strain of urination and physical labor. 46.16% of patients had hypertension. No significant link was found between comorbidities and ED. 38.45% of patients consumed tobacco or alcohol. Tobacco was a significant risk factor for ED. 57.67% of patients suffered from ED after treatment, indicating an improvement compared to 66.67% before treatment. However, 24.36% did not ejaculate during sexual intercourse. Conclusion: Medication treatment is the first-line treatment for BPH. However, it can lead to retrograde ejaculation, negatively impacting ejaculatory function. The results showed that the treatment improves patients’ sexuality (IIEF-5 score), but age and tobacco consumption increase the risk of sexual dysfunction.
基金supported by the National Natural Science Foundation of China(No.81901543 and No.81971333)the Key Research and Development Project of Anhui Province(2022e07020014)the Joint Fund for Medical Artificial Intelligence(MAI2022Q010).
文摘A previous study showed that the length of the foreskin plays a role in the risk of sexually transmitted infections and chronic prostatitis,which can lead to poor quality of sexual life.Here,the association between foreskin length and sexual dysfunction was evaluated.A total of 5700 participants were recruited from the andrology clinic at The First Affiliated Hospital of University of Science and Technology of China(Hefei,China).Clinical characteristics,including foreskin length,were collected,and sexual function was assessed by the International Index of Erectile Function-5(IIEF-5)and Premature Ejaculation Diagnostic Tool(PEDT)questionnaires.Men with sexual dysfunction were more likely to have redundant foreskin than men without sexual dysfunction.Among the 2721 erectile dysfunction(ED)patients and 1064 premature ejaculation(PE)patients,301(11.1%)ED patients and 135(12.7%)PE patients had redundant foreskin,respectively.Men in the PE group were more likely to have redundant foreskin than men in the non-PE group(P=0.004).Logistic regression analyses revealed that the presence of redundant foreskin was associated with increased odds of moderate/severe ED(adjusted odds ratio[aOR]=1.31,adjusted P=0.04),moderate PE(aOR=1.38,adjusted P=0.02),and probable PE(aOR=1.37,adjusted P=0.03)after adjusting for confounding variables.Our study revealed a positive correlation between the presence of redundant foreskin and the risk of sexual dysfunction,especially in PE patients.Assessment of the length of the foreskin during routine clinical diagnosis may provide information for patients with sexual dysfunction.
文摘Dear Editor,Primary bladder neck obstruction(PBNO)affects approximately 28%–54%of men[1].Its etiology remains unclear.Symptoms of PBNO present as voiding(e.g.,decreased force of stream,hesitancy,intermittent stream,and incomplete emptying),storage(e.g.,frequency,urgency,urge incontinence,and nocturia),or a combination of both[2].Untreated PBNO can lead to bladder dysfunction,bladder diverticula,hydronephrosis,and impaired renal function[3].
基金This study was supported by the Science & Technology Commission of Guangdong ProvinceP.R.China
文摘Objective To investigate the empty zona pellucida for use in the cryopreservation of human sperm. Materials & Methods Human and hamster zona pellucidae were evacuated and injected with testicular, epididymal and ejaculated sperm. The zona pellucidae with sperm were cryopreserved. Results After thawing, zona pellucidae were easily found, and sperm inside zona pellucidae were also easily observed. There were no differences in post-thaw motility and vitality between ejaculated and epididymal sperm groups (P>0.05), but these two parameters were lowered in testicular sperm group compared to both ejaculated and epididymal sperm (P<0.01). No significant difference was observed in post-thaw motilities among 6%, 7.5%, 9% glycerol concentrations (P>0.05). In addition, obvious differences in post-thaw motilities were not found between human and hamster empty zona pellucidae (P>0.05). Conclusion An evacuated zona pellucida is an ideal vehicle for the cryopreservation of a small number of human sperm.
文摘Aim: To assess the psychometric properties of the Chinese Index of Premature Ejaculation (CIPE). Methods: The sexual function of 167 patients with and 114 normai controls without premature ejaculation (PE) were evaluated with CIPE. All subjects were married and had regular sexual activity. The CIPE has 10 questions, focusing on libido, erectile function, ejaculatory latency, sexual satisfaction and difficulty in delaying ejaculation, self-confi dence and depression. Each question was responded to on a 5 point Likert-type scale. The individual question score and the total scale score were analyzed between the two groups. Results: There were no significant differences between the age, duration of marriage and educational level (P > 0.05) of patients with and vvithout PE and normai controls. The mean latency of patients with PE and normai controls were 1.6±1.2 and 10.2±9.5 minutes, respectively. Significant differences between patients with (26.7±4.6) PE and normai controls (41.9±4.0) were observed on the total score of CIPE (P < 0.01). Using binary logistic regression analysis, PE was significantly related to five questions of the original measure. They are the so-called the CIPE-5 and include: ejaculatory latency, sexual satisfaction of patients and sexual partner, difficulty in delaying ejaculation, anxiety and depression. Receiver Operat ing Characteristic (ROC) curve analysis of CIPE-5 questionnaire indicated that the sensitivity and specificity of CIPE were 97.60 % and 94.74 %, respectively. Employing the total score of CIPE-5, patients with PE could be divided into three groups: mild (>15 point) 19.8 %, moderate (10-14 point) 62.8 % and severe (< 9 point) 16.7 %. Conclusion: The CIPE-5 is a useful method for the evaluation of sexual function of patients with PE and can be used as a clinical endpoint for clinical trials studying the efficacy of pharmacologica] intervention.
文摘There are ongoing debates about the definition, classification and prevalence of premature ejaculation （PE）. The first evidence-based definition of PE was limited to heterosexual men with lifelong PE who engage in vaginal intercourse. Unfortunately, many patients with the complaint of PE do not meet these criteria. However, these men can be diagnosed as one of the PE subtypes, namely acquired PE, natural variable PE or premature-like ejaculatory dysfunction. Nevertheless, the validity of these subtypes has not yet been supported by evidence. The absence of a universally accepted PE definition and lack of standards for data acquisition have resulted in prevalence studies that have reported conflicting rates. The very high prevalence of 20%-30% is probably due to the vague terminology used in the definitions at the time when such surveys were conducted. Although many men may complain of PE when questioned for a population-based prevalence study, only a few of them will actively seek treatment for their complaint, even though most of these patients would define symptoms congruent with PE. The complaints of acquired PE patients may be more severe, whereas complaints of patients experiencing premature-like ejaculatory dysfunction seem to be least severe among men with various forms of PE. Although numerous treatment modalities have been proposed for management of PE, only antidepressants and topical anaesthetic creams have currently been proven to be effective. However, as none of the treatment modalities have been approved by the regulatory agencies, further studies must be carried to develop a beneficial treatment strategy for PE.
文摘Premature ejaculation(PE)is the most comm on male sexual dysfunction,which represents a diag no stic as well as a therapeutic challenge for physicians.However,no universally accepted definition is currently available for PE.As a result,physicians continue to diagnose patients with PE according to major guidelines set by the professional societies.These guidelines either recommend the use of validated questionnaires or patient-reported outcomes.Recent efforts directed toward classifying PE may help provide a better understanding of the prevalence and risk factors of this disorder.While the exact etiology of PE has not been clearly elucidated,several risk factors have been strongly reported in the literature.Clearly,to understand the revised definition of PE,its etiology and pathophysiology is necessary to improve the clinical management of this medical condition and form the basis of future research in this regard.In this review,we highlight the past and current definitions of PE and present an appraisal on the classifications and theories suggested for the etiopathogenesis of PE.
文摘Premature ejaculation （PE） is recognized to be the most common male sexual disorder. PE provides difficulties for professionals who treat this condition because there is neither a universally accepted definition nor a medication approved by the Food and Drug Administration （FDA）. Despite these shortcomings, physicians continue to diagnose their patients with PE according to major guidelines and treat them with either behavioral therapies or off-label medications. This review focuses on current and emerging treatment options and medications for PE. Advantages and limitations of each treatment option are discussed in the light of current published peer-reviewed literature.
文摘Sex has always been a taboo subject in Asian society. However, over the past few years, awareness in the field of men＇s sexual health has improved, and interest in sexual health research has recently increased. The epidemiology and prevalence of erectile dysfunction, hypogonadism and premature ejaculation in Asia are similar in the West. However, several issues are specific to Asian males, including culture and beliefs, awareness, compliance and the availability of traditional/complementary medicine. In Asia, sexual medicine is still in its infancy, and a concerted effort from the government, relevant societies, physicians and the media is required to propel sexual medicine to the forefront of health care.
文摘We evaluated the genotypes of the serotonin transporter gene （5-HTT） in patients with premature ejaculation （PE） to determine the role of genetic factors in the etiopathogenesis of PE and possibly to identify the patient subgroups. A total of 70 PE patients and 70 controls were included in this study. All men were heterosexual, had no other disorders and were either married or in a stable relationship. PE was defined as ejaculation that occurred within 1 min of vaginal intromission. Genomic DNA from patients and controls was analyzed using polymerase chain reaction, and allelic variations of the promoter region of the serotonin transporter gene （5-HTTLPR） were determined. The 5-HTTLPR （serotonin transporter promoter gene） genotypes in PE patients vs. controls were distributed as follows： L/L 16% vs. 17%, L/S 30% vs. 53% and S/S 54% vs. 28%. We examined the haplotype analysis for three polymorphisms of the 5-HTTLPR gene： LL, LS and SS. The appropriateness of the allele frequencies in the 5-HTTLPR gene was analyzed by the Hardy-Weinberg equilibrium using the Z-test. The short （S） allele of the 5-HTTLPR gene was significantly more frequent in PE patients than in controls （P 〈 0.05）. We suggest that the 5-HTTLPR gene plays a role in the pathophysiology of all primary PE cases. Further studies are needed to evaluate the relationship between 5-HTTLPR gene polymorphism and patient subgroup （such as primary and secondary PE） responses to selective serotonin reuptake inhibitors as well as ethnic differences.
文摘Penile hypersensitivity plays an important role in premature ejaculation （PE）, but differences in penile sensitivity among subtypes of PE are unknown. Therefore, we compared penile sensory thresholds in PE subtypes of lifelong and acquired PE, PE with and without erectile dysfunction （ED）, PE with an intravaginal ejaculation latency time 〈1 min and 〉1 min, and PE with and without orgasmic pleasure perceptual dysfunction. During August 2014 to January 2016, 136 patients with PE were included. Penile warm, cold, and vibratory thresholds were measured. Data of clinical characteristics, sexual life, Premature Ejaculation Diagnostic Tool （PEDT） score, and the 5-item version of the International Index of Erectile Function （IIEF-5） score were collected. Vibratory thresholds of the PE with ED group were higher in the right coronal sulcus （median amplitude： 4.92 vs 3.65 μm, P= 0.02） and the right penile shaft （median amplitude： 3.87 vs 3.30 μm, P = 0.03）, while differences in penile sensory thresholds between other subtypes were not significant. The median PEDT score was lower in the PE without ED group （12 vs 14, P 〈 0.001）. The IIEF-5 and PEDT scores were negatively correlated （r = -0.29, P 〈 0.001）. Patients with orgasmic pleasure perceptual dysfunction had a lower median IIEF-5 score （20 vs 21, P = 0.02）. Patients with PE and ED had lower penile sensitivity, and ED was associated with more severe symptoms and weaker orgasmic pleasure perception. In men with PE, management of comorbid ED is necessary. In case of side effects in erectile function, topical anesthetics should be cautiously used in men with PE and ED.
文摘We aimed to prospectively evaluate the influence of holmium laser enucleation of the prostate （HoLEP） on the overall postoperative sexual function of benign prostatic hyperplasia （BPH） patients with lower urinary tract symptoms （LUTS） and to explore the relationship between sexual function and LUTS. From January 2010 to December 2011, sixty sexually active consecutive patients with BPH who underwent HoLEP were prospectively enrolled in the study. All patients filled out the Male Sexual Health Questionnaire （MSHQ） for evaluation of their overall sexual function and the International Prostatic Symptom Score （IPSS） for pre- and post-operative 6 months evaluation of their voiding symptoms. The LUTS and sexual function changes were statistically analyzed. The preoperative and 6 months postoperative status of the patients was compared using uroflowmetry and IPSS questionnaires. The analysis revealed significant improvements following HoLEP. Among the sub-domains of the MSHQ, postoperative sexual function, including erection, ejaculation, sexual satisfaction, anxiety or sexual desire, did not significantly change after HoLEP （P 〉 0.05）, whereas satisfaction scores decreased slightly due to retrograde ejaculation in 38 patients （63.3%）. Sexual satisfaction improved significantly and was correlated with the improvements of all LUTS and the quality-of-life （QoL） domains in IPSS after surgery （QoL; relative risk [RR]： -0.293; total symptoms, RR： -0.411; P 〈 0.05）. The nocturia score was associated with the erectile function score （odds ratio 0.318, P = 0.029）. The change in ejaculatory scores did not show significant association with IPSS scores. HoLEP did not influence overall sexual function, including erectile function. In addition, sexual satisfaction improved in proportion with the improvement of LUTS.
文摘Normal sexual and reproductive functions depend largely on neurological mechanisms. Neurological defects in men can cause infertility through erectile dysfunction, ejaculatory dysfunction and semen abnormalities. Among the major conditions contributing to these symptoms are pelvic and retroperitoneal surgery, diabetes, congenital spinal abnormalities, multiple sclerosis and spinal cord injury, Erectile dysfunction can be managed by an increasingly invasive range of treatments including medications, injection therapy and the surgical insertion of a penile implant. Retrograde ejaculation is managed by medications to reverse the condition in mild cases and in bladder harvest of semen after ejaculation in more severe cases. Anejaculation might also be managed by medication in mild cases while assisted ejaculatory techniques including penile vibratory stimulation and eiectroejaculation are used in more severe cases. If these measures fail, surgical sperm retrieval can be attempted. Ejaculation with penile vibratory stimulation can be done by some spinal cord injured men and their partners at home, followed by in-home insemination if circumstances and sperm quality are adequate. The other options always require assisted reproductive techniques including intrauterine insemination or in vitrofertilization with or without intracytoplasmic sperm injection. The method of choice depends largely on the number of motile sperm in the ejaculate.
文摘Treatment of patients with lower urinary tract symptoms （LUTS） secondary to benign prostatic hyperplasia （BPH） may affect the quality of sexual function and ejaculation. The effect of new surgical procedures, which are currently available to treat BPH, on erection and ejaculation, has been poorly studied. This study aimed to assess the effect of thulium laser enucleation of the prostate （ThuLEP） on sexual function and retrograde ejaculation in patients with LUTS secondary to BPH. We performed a prospective study in 110 consecutive patients who had undergone ThuLEP to analyze changes in sexual function and urinary symptoms. To evaluate changes in erection and ejaculation, and the effect of urinary symptoms on the quality of life （QoL）, five validated questionnaires were used： the ICIQ-MLUTSsex, MSHQ-EjD, International Index of Erectile Function 5, International Prognostic Scoring System （IPSS） questionnaire, and QoL index of the intraclass correlation coefficients. Patients also underwent IPSS and flowmetry to assess the outcome of flow. Patients were evaluated before surgery and 3-6 months after ThuLEP, whereas those with previous abdominal surgery were excluded. The patients＇ mean age was 67.83 years. Postoperative urinary symptoms improved after surgery. No significant differences in erectile function before and after surgery were observed. As compared with other techniques described in the literature, the percentage of patients with conserved ejaculation increased by 52.7% after ThuLEP. ThuLEP positively affects urinary symptoms and their effect on the QoL of patients as assessed by questionnaire scores. While endoscopic management of BPH （e.g. transurethral resection of the prostate） causes retrograde ejaculation in most patients, those who undergo ThuLEP have conserved ejaculation and erectile function.
文摘The aim of the study was to evaluate the long-term outcomes of pelvic floor muscle （PFM） rehabilitation in males with lifelong premature ejaculation （PE）, using intravaginal ejaculatory latency time （IELT） and the self-report Premature Ejaculation Diagnostic Tool （PEDT） as primary outcomes. A total of 154 participants were retrospectively reviewed in this study, with 122 completing the training protocol. At baseline, all participants had an IELT 〈60 s and PEDT score 〉11. Participants completed a 12-week program of PFM rehabilitation, including physio-kinesiotherapy treatment, electrostimulation, and biofeedback, with three sessions per week, with 20 min for each component completed at each session. The effectiveness of intervention was evaluated by comparing the change in the geometric mean of IELT and PEDT values, from baseline, at 3, 6, and 12 months during the intervention, and at 24 and 36 months postintervention, using a paired sample 2-tailed t-test, including the associated 95% confidence intervals. Of the 122 participants who completed PFM rehabilitation, 111 gained control of their ejaculation reflex, with a mean IELT of 161.6 s and PEDT score of 2.3 at the 12-week endpoint of the intervention, representing an increase from baseline of 40.4 s and 17.0 scores, respectively, for IELT and PEDT （P 〈 0.0001）. Of the 95 participants who completed the 36-month follow-up, 64% and 56% maintained satisfactory eiaculation control at 24 and 36 months oostintervention, respectively.
